2. Nothing else matters if you can’t breathe

3. You are called stat to the ER

4. You meet in the - ER First things first--- What do you do? What do you know? What do you need?

5. Respiratory Failure : Definition: “The inability to maintain either normal delivery of O2 to the tissues or the removal of CO2from the tissues”

6. SIGNS and SYMPTOMS Patient will ….. have an RR >28 bpm have a HR > 120 bpm be diaphoretic unable to speak in full sentences begin to tire

7. Intubate and Ventilate Suction Bag Ventilate Intubate

8. WHAT TO DO WHAT TO SET FIRST Delivery of Inspired O2

9. Next Step FIO2 AND PEEP

10. MODES of MV

11. PHASE II Monitoring and Assessing Monitor Adjusting - primary controls Correcting an ABG Adjusting – secondary controls

12. Monitoring the patient Patient Assessment Hemodynamics Vital signs

13. Adjusting ventilator controls

15. ↓ or remove deadspace

16. ↑ Vt

17. ↑ f

18. To normalize a low PaCO2

19. ↑Deadspace

20. ↓ f

21. ↓ Vt

22. Increase a low PaO2

23. FIRST -↑ FiO2 by 5-10% up to 60%

24. THEN - ↑ PEEP by 5

25. Decrease a high PaO2

26. FIRST - ↓ FiO2 to < 60%

28. Waveforms

29. PHASE III – Weaning From The Ventilator

30. Assessment for Weaning Decreasing Ventilator Settings Weaning Methods

31. Assessment for Weaning ABG Bedside PFT

32. Decrease Ventilator Settings Ventilator Settings : RR,FIO2,PEEP LOWEST POSSIBLE VENTILATOR SETTINGS SIMV/IMV 4 breaths FIO2 of 40% PEEP 0f 5cm H2O

33. WEANING METHODS Traditional method/Trial and error/T-piece trial IMV/SIMV PSV IPAP support for difficult to wean

34. Summary of adverse conditions ↑ HR by > 20 bpm Δ in Bp by 10-20 torr ↑ in PaCO2 by 10 torr RR ↑ 10 or > 30 bpm Stridor

35. Chronically Ventilator-Dependent Patients 23 Definition: ventilator dependency remains following 3 months of weaning attempts. Once dependency established, goal is to restore highest level of independence.

36. END of LIFE Terminal Weaning

38. Decision is made by patient and/or family in consultation with physician.